Provider Demographics
NPI:1699164467
Name:EAGLEN, ROBERT JR (LPN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EAGLEN
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1631
Mailing Address - Country:US
Mailing Address - Phone:330-257-2740
Mailing Address - Fax:
Practice Address - Street 1:102 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1631
Practice Address - Country:US
Practice Address - Phone:330-257-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.150759-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse